Form ST-105 Indiana Department of Revenue State Form ...

Form ST-105

StateForm :19065 R'+/8-0-5

Indiana Department of Revenue

General SalesThx Exemption Certificate

locatedoutsideIndianamay usethis certificate.The claimedexemptionmust be allowedby Indiana

Indianaregisteredrelail merchantsand businesses

code. Exemption slatutesof other statesare not valid tbr purchasesfrom Indiana vendors.This exemption certilicate can not be issued for the

purchase of lLili/iqg, Vehicles, Watercraft, or Ai/crafr. Pttrcha.sermust be registered with the Depafiment of Revenue or the appropriate taxing

authorityofthe purchaser'sstateof residence.

Sales tax must be charged unless a!! information in each 6ection is fully completed by the purchaser. Purchasersnot able to provide all required

informationmust pay the tax and may file a ctaim for refund (Form GA- I lol-) directly with the Departmentof Revenue.

Name of Purchaser

City

Business Address

Zip

State _

P u r c h a s e rm u s t p r o v i d e m i n i m u m o f o n e I D n u n i b e r b e l c l w . t '

Provide your Indiana Registered Retail Merchant's Certificatc

TID and LOC Number as shown on your Certificate.

If not registered with the Indiana DOR, provide your State Tax

ID Number from anotherState......

*See instructions on the reverse side if vou do not have either number.

H

Is this a I

b l a n k e t p u r c h a s ee x e m p t i o n r e q u e s to r a I

TID# ( l0 digits)

LOC# ( 3 digits)

SrarelD#

Stateof Issue

s i n g l e p u r c h a s ee x e m p t i o n r e q u e s t ? ( c h e c k o n e )

D e s c r i p t i o no f i l e m s t o b e p u r c h a s e d .

Purchasermust indicatethe lype oI exemptionbeing claimedfor this purchase.(checkone or explain)

E Salesto a retailer,wholesaler,or manufacturerfor resale only.

E Saleof manufactu ng machinery tools. and equipmentto be useddirectly in direct production.

E Salesto nonprofft organizations claiming exemptionpursuantto SalesTax lnformation Bullelin #10.

(May not be usedfor personalhotel rooms and meals.)

E

Salesofrangible personalpropertypredominatelyused(greaterthen50 percent)in providing public transportation - provide USDOT#.

A personor corporalionwho is bauling undersomeoneelse'smotor carrierauthority,or has a contractas a school bus operator, must

providc their SS#or FID# in lieu of a StateID# in Section#1. USDOT# -

E Salesto persons,occupationallyengagedas famers, to be useddirectly in productionof agricultural productsfor sale.

Note: A farmer not possessinga StateBusinessLicense#may entera FID# or a SS# in lieu of a StateID# in Section#1.

E Salesto a contractor for exemptprojects(suchas public $chools,Sovemment,or nonprofits).

E Salesto Indiana Governmental Units (agencies,cilies, towns. municipalities,public schools,and slateuniversities).

El Sales to the United States Federal Government - show agency name.

Note: A U.S. Government asencv should enter its Federal Identification Number (FID#) in Section #1 in lieu of a State ID#.

E

Other - explain.

I herebycerlify under the penaltiesof perjury that lhe propeny purchasedby the use of this exemptioncertificateis to be used for an exempt

purposepursuanlto the StateCrossRetail SalesTax Act, IndianaCode6-2.5,and the item purchasedis not a utility, vehicle,watercraft,or aircraft.

I confirm my undeBtandingthat misuse,(?ifrer egligentor intentioral), and/orfraudulentuseofthis certificatemay subjectboth me personally

and/orthe businessentity I represenlto the impositionoftax, interest,and civil and/orcriminal penalties.

Signature of Purchaser

Date

Printed Name

Title

The Indiana Dcpartntent of Revenue may request verification of registration in another state if you are an out-of-state purchaser.

Seller must keep this certificate on file to support exempt sales.

For.mST-105

General Infonnation and Instructions

All four (4) sectionsof the ST-I 05 mustbe completedor the exemptionis not valid andthe seller is responsible

for thecollection of the Indianasalestax.

A) This sectionrequires an identification number. In mostcasesthis numberwill be an Indiana

DeparunentofRevenueissuedTaxpayerldentificationNumber(TID# - seenotebelow) usedfor

Indianasalesand/orwithholdingtax reporting. If the purchaseris from anotherstateanddoei not

license,or StateissuedID# mustbe provided.

possess

anIndianaTID#, a residentstate'sbusiness

possessing

purchaser

either

an

IndianaTID# or anotherStateID#, the following

not

B) Exceptions For a

may be usedin lieu of this requirement.

tr'ederalGovernment- placeyour FID# in the StateID# space.

Farmer - placeyour SS#or FID# in theStateID# space.

Public transportation haulers operatingunderanothermotor carrierauthority,or witb a contractasa

schoolbusoperator,mustindicatetheir SS#or FID# in the StateID# space.

Nonprolit Organization - mustshowits FID# in the StateID# space.

A) Check a box to indicateif this is a singlepurchaseor blanketexemption.

B) Describeproductbeing purchased.

A) Purchasermust checkthe reasonfor exemption.

B) Purchasermust be able to provide additionalinformation if requested.

A) Purchasermust sign and date the form.

B) Printed nameand title of signermust be shown.

Note: The Indiana Tlrxpayer Identification Number (TID#) is a ten (10) digit number followed by a thtee (3)

digit LOC#. The TID# is alsoknown as the following:

a) Registered Retail Merchant Certificat€

b) Tax Exempt Identification Number

c) SalesTax Identification Number

d) Withholding Tax Identification Number

The RegisteredRetail MerchantCertificateissuedby the Indiana DepartrnentofRevenueshows

the TID# ( I 0 digits) and the LOC# (3 digits) at the top right of the certificate'

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